Systematic Evaluation of Large Vision-Language Models for Surgical Artificial Intelligence

Large Vision-Language Models offer a new paradigm for AI-driven image understanding, enabling models to perform tasks without task-specific training. This flexibility holds particular promise across medicine, where expert-annotated data is scarce. Yet, VLMs' practical utility in intervention-focused domains--especially surgery, where decision-making is subjective and clinical scenarios are variable--remains uncertain. Here, we present a comprehensive analysis of 11 state-of-the-art VLMs across 17 key visual understanding tasks in surgical AI--from anatomy recognition to skill assessment--using 13 datasets spanning laparoscopic, robotic, and open procedures. In our experiments, VLMs demonstrate promising generalizability, at times outperforming supervised models when deployed outside their training setting. In-context learning, incorporating examples during testing, boosted performance up to three-fold, suggesting adaptability as a key strength. Still, tasks requiring spatial or temporal reasoning remained difficult. Beyond surgery, our findings offer insights into VLMs' potential for tackling complex and dynamic scenarios in clinical and broader real-world applications.

MicroVQA: A Multimodal Reasoning Benchmark for Microscopy-Based Scientific Research

Scientific research demands sophisticated reasoning over multimodal data, a challenge especially prevalent in biology. Despite recent advances in multimodal large language models (MLLMs) for AI-assisted research, existing multimodal reasoning benchmarks only target up to college-level difficulty, while research-level benchmarks emphasize lower-level perception, falling short of the complex multimodal reasoning needed for scientific discovery. To bridge this gap, we introduce MicroVQA, a visual-question answering (VQA) benchmark designed to assess three reasoning capabilities vital in research workflows: expert image understanding, hypothesis generation, and experiment proposal. MicroVQA consists of 1,042 multiple-choice questions (MCQs) curated by biology experts across diverse microscopy modalities, ensuring VQA samples represent real scientific practice. In constructing the benchmark, we find that standard MCQ generation methods induce language shortcuts, motivating a new two-stage pipeline: an optimized LLM prompt structures question-answer pairs into MCQs; then, an agent-based `RefineBot' updates them to remove shortcuts. Benchmarking on state-of-the-art MLLMs reveal a peak performance of 53\%; models with smaller LLMs only slightly underperform top models, suggesting that language-based reasoning is less challenging than multimodal reasoning; and tuning with scientific articles enhances performance. Expert analysis of chain-of-thought responses shows that perception errors are the most frequent, followed by knowledge errors and then overgeneralization errors. These insights highlight the challenges in multimodal scientific reasoning, showing MicroVQA is a valuable resource advancing AI-driven biomedical research. MicroVQA is available at https://huggingface.co/datasets/jmhb/microvqa, and project page at https://jmhb0.github.io/microvqa.

Video Action Differencing

How do two individuals differ when performing the same action? In this work, we introduce Video Action Differencing (VidDiff), the novel task of identifying subtle differences between videos of the same action, which has many applications, such as coaching and skill learning. To enable development on this new task, we first create VidDiffBench, a benchmark dataset containing 549 video pairs, with human annotations of 4,469 fine-grained action differences and 2,075 localization timestamps indicating where these differences occur. Our experiments demonstrate that VidDiffBench poses a significant challenge for state-of-the-art large multimodal models (LMMs), such as GPT-4o and Qwen2-VL. By analyzing failure cases of LMMs on VidDiffBench, we highlight two key challenges for this task: localizing relevant sub-actions over two videos and fine-grained frame comparison. To overcome these, we propose the VidDiff method, an agentic workflow that breaks the task into three stages: action difference proposal, keyframe localization, and frame differencing, each stage utilizing specialized foundation models. To encourage future research in this new task, we release the benchmark at https://huggingface.co/datasets/jmhb/VidDiffBench and code at http://jmhb0.github.io/viddiff.

SurgiSAM2: Fine-tuning a foundational model for surgical video anatomy segmentation and detection

Background: We evaluate SAM 2 for surgical scene understanding by examining its semantic segmentation capabilities for organs/tissues both in zero-shot scenarios and after fine-tuning. Methods: We utilized five public datasets to evaluate and fine-tune SAM 2 for segmenting anatomical tissues in surgical videos/images. Fine-tuning was applied to the image encoder and mask decoder. We limited training subsets from 50 to 400 samples per class to better model real-world constraints with data acquisition. The impact of dataset size on fine-tuning performance was evaluated with weighted mean Dice coefficient (WMDC), and the results were also compared against previously reported state-of-the-art (SOTA) results. Results: SurgiSAM 2, a fine-tuned SAM 2 model, demonstrated significant improvements in segmentation performance, achieving a 17.9% relative WMDC gain compared to the baseline SAM 2. Increasing prompt points from 1 to 10 and training data scale from 50/class to 400/class enhanced performance; the best WMDC of 0.92 on the validation subset was achieved with 10 prompt points and 400 samples per class. On the test subset, this model outperformed prior SOTA methods in 24/30 (80%) of the classes with a WMDC of 0.91 using 10-point prompts. Notably, SurgiSAM 2 generalized effectively to unseen organ classes, achieving SOTA on 7/9 (77.8%) of them. Conclusion: SAM 2 achieves remarkable zero-shot and fine-tuned performance for surgical scene segmentation, surpassing prior SOTA models across several organ classes of diverse datasets. This suggests immense potential for enabling automated/semi-automated annotation pipelines, thereby decreasing the burden of annotations facilitating several surgical applications.

Temporal Preference Optimization for Long-Form Video Understanding

Despite significant advancements in video large multimodal models (video-LMMs), achieving effective temporal grounding in long-form videos remains a challenge for existing models. To address this limitation, we propose Temporal Preference Optimization (TPO), a novel post-training framework designed to enhance the temporal grounding capabilities of video-LMMs through preference learning. TPO adopts a self-training approach that enables models to differentiate between well-grounded and less accurate temporal responses by leveraging curated preference datasets at two granularities: localized temporal grounding, which focuses on specific video segments, and comprehensive temporal grounding, which captures extended temporal dependencies across entire video sequences. By optimizing on these preference datasets, TPO significantly enhances temporal understanding while reducing reliance on manually annotated data. Extensive experiments on three long-form video understanding benchmarks--LongVideoBench, MLVU, and Video-MME--demonstrate the effectiveness of TPO across two state-of-the-art video-LMMs. Notably, LLaVA-Video-TPO establishes itself as the leading 7B model on the Video-MME benchmark, underscoring the potential of TPO as a scalable and efficient solution for advancing temporal reasoning in long-form video understanding. Project page: https://ruili33.github.io/tpo_website.

BIOMEDICA: An Open Biomedical Image-Caption Archive, Dataset, and Vision-Language Models Derived from Scientific Literature

The development of vision-language models (VLMs) is driven by large-scale and diverse multimodal datasets. However, progress toward generalist biomedical VLMs is limited by the lack of annotated, publicly accessible datasets across biology and medicine. Existing efforts are restricted to narrow domains, missing the full diversity of biomedical knowledge encoded in scientific literature. To address this gap, we introduce BIOMEDICA, a scalable, open-source framework to extract, annotate, and serialize the entirety of the PubMed Central Open Access subset into an easy-to-use, publicly accessible dataset. Our framework produces a comprehensive archive with over 24 million unique image-text pairs from over 6 million articles. Metadata and expert-guided annotations are also provided. We demonstrate the utility and accessibility of our resource by releasing BMCA-CLIP, a suite of CLIP-style models continuously pre-trained on the BIOMEDICA dataset via streaming, eliminating the need to download 27 TB of data locally. On average, our models achieve state-of-the-art performance across 40 tasks - spanning pathology, radiology, ophthalmology, dermatology, surgery, molecular biology, parasitology, and cell biology - excelling in zero-shot classification with a 6.56% average improvement (as high as 29.8% and 17.5% in dermatology and ophthalmology, respectively), and stronger image-text retrieval, all while using 10x less compute. To foster reproducibility and collaboration, we release our codebase and dataset for the broader research community.

Automated Generation of Challenging Multiple-Choice Questions for Vision Language Model Evaluation

The rapid development of vision language models (VLMs) demands rigorous and reliable evaluation. However, current visual question answering (VQA) benchmarks often depend on open-ended questions, making accurate evaluation difficult due to the variability in natural language responses. To address this, we introduce AutoConverter, an agentic framework that automatically converts these open-ended questions into multiple-choice format, enabling objective evaluation while reducing the costly question creation process. Our experiments demonstrate that AutoConverter can generate correct and challenging multiple-choice questions, with VLMs demonstrating consistently similar or lower accuracy on these questions compared to human-created ones. Using AutoConverter, we construct VMCBench, a benchmark created by transforming 20 existing VQA datasets into a unified multiple-choice format, totaling 9,018 questions. We comprehensively evaluate 33 state-of-the-art VLMs on VMCBench, setting a new standard for scalable, consistent, and reproducible VLM evaluation.

Feather the Throttle: Revisiting Visual Token Pruning for Vision-Language Model Acceleration

Recent works on accelerating Vision-Language Models show that strong performance can be maintained across a variety of vision-language tasks despite highly compressing visual information. In this work, we examine the popular acceleration approach of early pruning of visual tokens inside the language model and find that its strong performance across many tasks is not due to an exceptional ability to compress visual information, but rather the benchmarks' limited ability to assess fine-grained visual capabilities. Namely, we demonstrate a core issue with the acceleration approach where most tokens towards the top of the image are pruned away. Yet, this issue is only reflected in performance for a small subset of tasks such as localization. For the other evaluated tasks, strong performance is maintained with the flawed pruning strategy. Noting the limited visual capabilities of the studied acceleration technique, we propose FEATHER (Fast and Effective Acceleration wiTH Ensemble cRiteria), a straightforward approach that (1) resolves the identified issue with early-layer pruning, (2) incorporates uniform sampling to ensure coverage across all image regions, and (3) applies pruning in two stages to allow the criteria to become more effective at a later layer while still achieving significant speedup through early-layer pruning. With comparable computational savings, we find that FEATHER has more than $5\times$ performance improvement on the vision-centric localization benchmarks compared to the original acceleration approach.

Apollo: An Exploration of Video Understanding in Large Multimodal Models

Despite the rapid integration of video perception capabilities into Large Multimodal Models (LMMs), the underlying mechanisms driving their video understanding remain poorly understood. Consequently, many design decisions in this domain are made without proper justification or analysis. The high computational cost of training and evaluating such models, coupled with limited open research, hinders the development of video-LMMs. To address this, we present a comprehensive study that helps uncover what effectively drives video understanding in LMMs. We begin by critically examining the primary contributors to the high computational requirements associated with video-LMM research and discover Scaling Consistency, wherein design and training decisions made on smaller models and datasets (up to a critical size) effectively transfer to larger models. Leveraging these insights, we explored many video-specific aspects of video-LMMs, including video sampling, architectures, data composition, training schedules, and more. For example, we demonstrated that fps sampling during training is vastly preferable to uniform frame sampling and which vision encoders are the best for video representation. Guided by these findings, we introduce Apollo, a state-of-the-art family of LMMs that achieve superior performance across different model sizes. Our models can perceive hour-long videos efficiently, with Apollo-3B outperforming most existing $7$B models with an impressive 55.1 on LongVideoBench. Apollo-7B is state-of-the-art compared to 7B LMMs with a 70.9 on MLVU, and 63.3 on Video-MME.

DeforHMR: Vision Transformer with Deformable Cross-Attention for 3D Human Mesh Recovery

Human Mesh Recovery (HMR) is an important yet challenging problem with applications across various domains including motion capture, augmented reality, and biomechanics. Accurately predicting human pose parameters from a single image remains a challenging 3D computer vision task. In this work, we introduce DeforHMR, a novel regression-based monocular HMR framework designed to enhance the prediction of human pose parameters using deformable attention transformers. DeforHMR leverages a novel query-agnostic deformable cross-attention mechanism within the transformer decoder to effectively regress the visual features extracted from a frozen pretrained vision transformer (ViT) encoder. The proposed deformable cross-attention mechanism allows the model to attend to relevant spatial features more flexibly and in a data-dependent manner. Equipped with a transformer decoder capable of spatially-nuanced attention, DeforHMR achieves state-of-the-art performance for single-frame regression-based methods on the widely used 3D HMR benchmarks 3DPW and RICH. By pushing the boundary on the field of 3D human mesh recovery through deformable attention, we introduce an new, effective paradigm for decoding local spatial information from large pretrained vision encoders in computer vision.